Individual
DAVID JEROME LUBBERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2160
(859) 301-3932
Mailing address
PO BOX 932163, CLEVELAND, OH 44193-0001
(586) 412-4000
(586) 412-4100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
24507
KY
2085R0202X
Diagnostic Radiology Physician
Primary
24507
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0060564
—
OH
05
—
0592569
—
OH
01
—
300013439
RRMC
—
05
—
64245079
—
KY
Enumeration date
08/22/2005
Last updated
08/07/2013
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